Atrial fibrillation (AFib)

Atrial fibrillation, or AFib, occurs when rapid, disorganized electrical signals cause the heart’s two upper chambers, the atria, to contract very quickly and irregularly, or fibrillate. Atrial fibrillation causes blood to gather in the atria because it is not pumping completely into the ventricles, the lower chambers of the heart.

What is atrial fibrillation?

Atrial fibrillation, also known as A-fib or AF, is the most common condition associated with an abnormal rate or rhythm of the heartbeat, or arrhythmia. More than 2.3 million people in the United States are affected by atrial fibrillation, and more than 160,000 new cases are diagnosed every year. Untreated, atrial fibrillation can raise the risk of stroke more than five-fold and has also been shown to double the risk of death.

The UF Health Cardiovascular Center in Jacksonville is uniquely qualified to diagnose and treat atrial fibrillation with access to the latest research and technologies that help control the condition as quickly as possible, so patients can get back to a full, healthy life.

Atrial fibrillation: Types

There are three main types of atrial fibrillation:

• Paroxysmal atrial fibrillation - alternates back and forth between normal and abnormal rhythms
• Permanent atrial fibrillation - abnormal rhythms present all of the time
• Persistent atrial fibrillation - abnormal rhythms last longer than one week or require a small delivery of electrical energy or medications to reset the heart back to a normal rhythm (sinus)

Atrial fibrillation: Risk factors

There are a number of risk factors associated with atrial fibrillation. Patients with one or more of the following conditions have a much higher chance of developing atrial fibrillation than the general population:

• Atherosclerotic heart disease
• Congestive heart failure
• Heart valve disease
• High blood pressure
• Obesity
• Obstructive sleep apnea
• Thyroid problems

Atrial fibrillation: Symptoms

Some people who have atrial fibrillation don’t experience any symptoms. Those who do have symptoms may experience one or more of the following:

• Chest pain
• Confusion
• Heart palpitations
• Irregular heartbeat
• Lightheadedness or dizziness
• Shortness of breath
• Trouble exercising
• Weakness or fatigue

Some patients who experience atrial fibrillation over a long period of time may become used to feeling fatigued and not notice symptoms.

Atrial fibrillation: Diagnosis

When you come to the UF Health Cardiovascular Center, our heart team experts will discuss your symptoms and make an assessment. If our experts suspect that you may have atrial fibrillation, we may suggest one or more of the following tests:

• A blood test can help rule out a thyroid problem or other substances in the blood that could be causing the atrial fibrillation.
• A chest X-ray can help determine if a patient has another condition in the lungs that could be causing symptoms.
• An echocardiogram provides video images of the heart in motion so a doctor can determine if a patient has underlying structural heart disease.
• An electrocardiogram (ECG) is the primary method for diagnosing atrial fibrillation. It measures the activity of the heart.
• A Holter monitor assesses the heart’s activity over a longer period of time (usually at least 24 hours) to give doctors a fuller picture of the heart’s rhythms.

Once our heart team experts have diagnosed your condition, they will work with you to develop an individualized treatment plan.

Atrial fibrillation: Treatment

If you have atrial fibrillation, symptoms may come and go over time, or may be persistent. A cardiologist will discuss the symptoms with you to determine proper treatment based on your unique needs. Treatment will depend on:

• How long you have had atrial fibrillation
• Risk factors that may be present for stroke
• Severity of symptoms
• The underlying cause of the atrial fibrillation

In general, the goals of treatment of this condition are to reset the rhythm of the heart, control the heart rate and prevent blood clots. Our heart team experts tailor a specific therapy on an individual basis, offering many advanced and state-of-the-art treatment options.

The majority of patients with atrial fibrillation need some type of anticoagulant (“blood thinner”) to lower their risk of stroke. Patients who are older and have coexisting cardiac or vascular conditions are at a higher risk. Our heart team experts will be able to accurately determine the level of your risk and prescribe an appropriate therapy for you.

Additional state-of-the-art therapies include:

• Direct-current cardioversion (DCCV) uses electric shock to momentarily stop — and then restart — the heart’s activity. This shock is delivered via paddles or patches on the chest while patients are sedated.
• Drug-induced cardioversion uses medications known as antiarrhythmics to help correct a heartbeat. These medications may be delivered orally (by mouth) or intravenously (by vein).
• Convergent ablation, also known as a hybrid procedure, begins with a cardiothoracic surgeon making a small incision in the chest to deliver heat (radiofrequency energy) followed by a cardiologist performing a standard radiofrequency catheter ablation to alter heart tissue, stopping the arrhythmia. This procedure is best used for patients who have persistent atrial fibrillation.
• Cryothermal balloon ablation uses a cold temperature balloon energy to alter heart tissue, thus stopping the arrhythmia.
• Minimally invasive surgical ablation, also known as a mini-maze procedure, uses small incisions in the chest to reach the heart with an ablation device to alter the heart tissue.
• Left atrial appendage closure introduces a closure device through a large vein in the leg and delivers it to the heart to close the left atrial appendage, which can help reduce the risk of stroke and eliminate the need for long-term blood thinning anticoagulant medications.
• Open surgical (maze) procedure that requires opening the chest cavity to reach the heart and making a number of incisions on the left and right atria to form scar tissue. The scar tissue conducts electricity allowing for the interruption of abnormal rhythms.
• Pacemaker (PPM) implantation and AV nodal ablation places a small device in the chest or abdomen to help control heart rhythms with low-energy electrical pulses after a catheter is passed into the blood vessels and radiofrequency energy is delivered to the heart tissue to allow impulses to transfer from the top of the heart to the lower chambers.
• Radiofrequency catheter ablation inserts a catheter in the blood vessels to reach the heart and uses a high-frequency radio pulse to generate heat, stopping the arrhythmia.

Why choose UF Health Jacksonville?

The UF Health Cardiovascular Center includes internationally recognized heart experts who are leaders in cardiac care, research and education. These accomplished physicians have access to the most sophisticated equipment available and are able to provide our patients with state-of-the-art diagnostic, therapeutic and rehabilitative cardiac services. Working together with cardiothoracic surgeons, our team offers a variety of medications and treatment options that can increase quality of life and minimize risk of stroke.

To better meet your needs, the Center also offers our Comprehensive Atrial Fibrillation Program, which individualizes treatment for each patient based on the type of atrial fibrillation. Other comprehensive heart programs, include a coronary interventional program, nuclear program, electrophysiology program, noninvasive program and peripheral interventional program.

UF Health Jacksonville is renowned for treating patients with complex diseases and being on the forefront of advancing the science of interventional cardiology. Many leading-edge interventional therapies offered in Northeast Florida are only available at the UF Health Cardiovascular Center – Jacksonville.